Clinical

Rifaximin plus lactulose reduces severity of hepatic encephalopathy

Last Updated: 2008-11-04 14:01:53 -0400 (Reuters Health)

By Martha Kerr

SAN FRANCISCO (Reuters Health) - The non-absorbed antibiotic rifaximin (Xifaxan, Salix Pharmaceuticals) added to standard treatment of hepatic encephalopathy with lactulose significantly reduces the number of hospitalizations for hepatic encephalopathy and shortens the length of hospital stay.

Those findings were presented here at The Liver Meeting 2008, the annual meeting of the American Association for the Study of Liver Diseases (AASLD) by Dr. Parvez S. Mantry of The Liver Institute at Methodist Dallas Medical Center, Texas.

Dr. Mantry described a retrospective review of medical records of 123 patients with end-stage liver disease seen on the liver transplantation unit at his institution. Fifty-eight of the patients received lactulose monotherapy for a mean duration of 24 months, while 65 patients received adjunctive rifaximin, 400-1200 mg/day, for a mean duration of 14 months after lactulose monotherapy.

"The risk of hospitalization for hepatic encephalopathy during adjunctive rifaximin treatment was 87% lower than during the preceding period with lactulose monotherapy," Dr. Mantry told meeting attendees.

Mean hospitalizations per patient were 0.26 with rifaximin plus lactulose and 0.95 with lactulose alone, for an odds ratio (OR) of 0.13.

The mean duration of hospitalizations for hepatic encephalopathy was shorter during adjunctive rifaximin (1.1 days) compared with lactulose monotherapy (2.4 days).

Treatment, age, and MELD score were independent predictors of hospitalization for hepatic encephalopathy.

"By reducing hospitalizations, rifaximin may reduce morbidity associated with hospitalization and overall costs associated with hepatic encephalopathy," Dr. Mantry concluded, adding, "Prospective studies to further investigate the potential therapeutic and pharmaco-economic benefits of rifaximin for hepatic encephalopathy are ongoing."